Geographic Inequities in Healthcare Access Across New York City

1 Introduction & Motivation

New York City, with its vast and diverse population of over 8.4 million residents, is supported by a world-class healthcare system encompassing renowned hospitals, academic medical centers, and community clinics. However, equitable access to this system remains elusive. Residents in outer boroughs and historically under-resourced neighborhoods often struggle with timely and affordable primary care, which is crucial for preventive services, early intervention, chronic disease management, and overall public health.

Aggregate citywide statistics, such as total hospitals or providers, frequently conceal significant neighborhood-level disparities. Healthcare is experienced locally—shaped by walking distances, public transit reliability, transportation options, and financial barriers. A facility across the city might as well be unavailable to someone facing these obstacles.

This project shifts focus to the census tract level to uncover intra-borough variations and intersecting barriers. It investigates interactions between physical proximity to facilities and socioeconomic factors, including income, insurance status, poverty, racial/ethnic composition, and foreign-born residency. Recent studies continue to highlight persistent outer-borough gaps, with initiatives like school-based mental health clinics targeting the Bronx and central Brooklyn underscoring ongoing needs.

These patterns hold policy significance, informing interventions like facility expansions, mobile units, improved transit links, and enhanced insurance enrollment. True equity demands rigorous measurement, ongoing evaluation, and targeted action.

2 The Big Question & Why It Matters

Overarching Question (OQ):
How does geographic access to healthcare facilities vary across New York City at the census tract level, and what socioeconomic disparities exist in healthcare access?

Geographic access shapes real-world care utilization, but economic and institutional barriers can override proximity. Higher-income areas may mitigate distance through mobility, while others face multiple hurdles.

To address this overarching question, the analysis examines healthcare access through several interconnected dimensions rather than treating access as a single metric. These dimensions include:

1. Geographic Distribution (Matthew): Which census tracts are true “healthcare deserts” (less than half the land area within a 10-minute walk of any facility)?
2. Borough & Neighborhood Supply (Imani): How many facilities actually exist per person in each borough and ZIP code?
3. Income & Affordability (Jason): How does household income affect the ability to obtain timely care, even when a facility is nearby?
4. Socioeconomic & Racial Patterns (Zhuohan & Saoni): How strongly do poverty, race/ethnicity, and foreign-born status predict living in a low-access tract or being uninsured?
5. Insurance as a Second Barrier (Yashvi): How does lack of health insurance compound the problem of physical distance?

Together, these perspectives allow for a more comprehensive understanding of healthcare access in New York City. The goal is to explain how and why they arise and to identify which factors most strongly contribute to unequal access across neighborhoods.

3 Data & Approach (Non-Technical)

Sources comprise the NYC Facilities Database for primary care-capable sites (hospitals, diagnostic/treatment centers, FQHCs) and American Community Survey (ACS) five-year estimates for tract-level demographics: population, median income, poverty, uninsurance, race/ethnicity, and foreign-born share.

Geographic access is modeled via 10-minute walking catchments around facilities, overlaid on census tracts to calculate coverage percentages. Per-capita metrics adjust supply for population demand. Regression and correlation analyses explore socioeconomic links. Tract-level granularity, supplemented by visualizations, exposes variations masked by borough averages and overlapping vulnerabilities..

4 Key Findings (Integrated)

Healthcare access in NYC remains markedly uneven, driven by geography, supply-demand mismatches, affordability, and indirect demographic influences.

About 9% of census tracts qualify as healthcare deserts, with under 50% of land area within a 10-minute walk of primary care facilities, impacting over 500,000 residents. These cluster predominantly in the Bronx, eastern Brooklyn, and parts of Queens, while Manhattan enjoys extensive coverage (Figure 1). Recent reports affirm outer-borough under-provision in primary care and specialized services.

Deserts concentrated in outer boroughs, aligning with ongoing disparities.

Population-adjusted metrics sharpen disparities: Manhattan boasts the highest facilities per capita, whereas Queens and Staten Island rank lowest, highlighting inadequate scaling in growing areas (Figure 2). Brooklyn leads in raw counts but lags per resident in certain neighborhoods.

Population adjustment exposes outer-borough shortfalls.

Affordability emerges as a pivotal barrier. Lower-income tracts exhibit elevated uninsurance rates, hindering utilization despite proximity (Figure 3). Enrollment assistance centers are disproportionately scarce in Queens, the Bronx, and Staten Island, perpetuating cycles of limited access (Figure 4).

Affordability drives practical access.

EFewer centers in underserved boroughs.

Foreign-born residents, comprising a substantial city portion, show no robust linear correlation with provider density (per 10,000 residents). Scatterplots and regressions indicate near-zero overall relationship, though select immigrant-dense tracts overlap with low-supply areas (Figure 5). Barriers like language and cost disproportionately affect immigrants, yet proximity patterns are not directly predictive.

Providers per 10,000 vs. % Foreign-Born: Minimal relationship.

Walking proximity displays weak ties to income (minor negative association, small magnitude, p<0.001) and none to minority share (p=0.778). Low explanatory power suggests dominance of non-demographic factors like urban density and transit (Figures 6 & 7).

Slight negative, small effect.

No significant relationship.

Racial/ethnic and immigrant status do not directly forecast poor geographic access after structural controls. Disparities manifest indirectly: minority and immigrant communities often reside in poverty-impacted, low-supply neighborhoods due to historical segregation and investment patterns.

Ultimately, proximity insufficiently guarantees utilization—economic and institutional hurdles frequently dominate. Higher-resource areas offset distance advantages, while vulnerable tracts endure multilayered deficits. Maps, bar charts, and scatterplots collectively depict these intersecting, place-specific inequities.

5 How This Fits with Prior Research

Findings resonate with extensive literature documenting distance barriers to preventive care and neighborhood ties to outcomes. NYC-specific studies repeatedly note outer-borough and socioeconomic gradients, amplified post-pandemic.

This work advances the field via updated data capturing recent shifts, tract-scale resolution revealing hidden deserts, and holistic integration of dimensions. Economic drivers predominate; race/ethnicity and nativity operate indirectly through residential sorting and resource allocation—consistent with structural explanations over individual ones. It bolsters calls for place-based equity strategies.

6 Limitations & Uncertainty

Data limitations include omitted facility attributes like capacity, wait times, or service quality. Walking focus underweights transit, driving, or reliability issues. Cross-sectional design yields associations, not causation; patterns may evolve with openings/closures or policies. Source timing variances risk minor inconsistencies. Tract aggregation overlooks individual behaviors, like cross-neighborhood care. Nonetheless, it delivers a robust snapshot of structural inequities and priority areas.

7 Implications & Next Steps

Targeted investments should focus on identified deserts in the Bronx, Queens, and eastern Brooklyn: expanding primary care, FQHCs, mobiles, and telehealth. Affordability demands bolstered outreach, enrollment sites, and culturally competent services, especially for immigrants.

Integrate healthcare with transit and housing planning to mitigate mobility gaps. Address indirect demographic disparities via anti-segregation efforts and equitable resource distribution.

Future directions: Incorporate multimodal travel times, real-time capacity/utilization, and longitudinal outcome tracking. Granular, intersectional analyses can refine interventions toward sustainable equity.